What are prior authorizations?

Prior authorizations are an important process that requires healthcare providers to obtain approval from a health insurance company or pharmacy benefit manager before a specific medication can be prescribed to a patient. This process is typically implemented to ensure that the prescribed medication is medically necessary and appropriate for the patient's condition, particularly for high-cost medications, and to manage healthcare costs effectively.

The requirement for providers to obtain this approval is rooted in the need for insurers to control expenditures on drugs and ensure proper drug utilization. By evaluating the necessity of the medication in advance, insurance companies can manage their drug formulary effectively, ensuring that patients receive the most suitable treatment while maintaining cost control.

In contrast to the correct answer, advertising medications does not involve prior authorizations, nor does it relate to patient requests. Instead, it pertains to how medications are marketed to both providers and patients. Also, while patients may need to be informed about prior authorizations, they are not the ones who directly request approvals; that responsibility lies with the providers. Lastly, prior authorizations do not directly increase drug prices, although they can influence a patient's access to medications and may lead to delays in treatment.